【歌】经水违期号曰愆，或多或少或流连，过期涩少因无血，热盛脾虚则向前，乍热乍痛须细审，适来适断
看风烟，逾期五十经还漏，室女停经有避年。
【论】经曰∶饮食入胃，游溢精气，上输于脾。脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经
并行。故心脾和平，则经候如常矣。苟或饮食失节，起居违宜，脾胃亏损，则经不调也。
赵养葵曰∶不及期来者，有火也，滋水则火自平矣，六味丸。如不及期而来多者，本方加海螵蛸、柴胡、
白芍。如半月十日一来，属气虚，补中汤。如过期不来者，无火也，本方加艾叶。脉迟色淡加炮姜、肉桂，此其大略
耳。其间亦有不及期而无火者，过期而有火者，有过期而多者，不及期而少者，不可拘于一定，当辨脉之迟数，禀
之虚实，形之强弱，年之多寡而施治之。如肝脾热者，四物加减。脾肺虚弱者，补中益气汤。肝脾郁结者，归脾
汤。怒动肝火者，加味逍遥散。肝肾阴虚者，六味丸。盖脾为化生之源，心统诸经之血，而阳气生于阴精，故宜补
心脾肾也。
【脉】寸关脉调和如故，尺脉绝不至者，当患少腹痛引腰痛，气滞上攻胸臆也。寸口脉浮而弱，浮则为虚，
弱则无血。脉至状如琴弦，苦小腹痛，月水不利，孔窍生疮。少阴脉弱而微，微则少血，弱则发热。肝脉沉，主月
水不利，腹胀满，腰间痛。
赶前
先期而至曰赶前，血热阴虚土不坚，怒气伤肝及劳役，固经凉血始安然。
四物三补丸。
落后
只因血少故来迟，涩少无痛大补之，色淡脉虚皆不足，养荣
归芍及参 。
滋血汤。
过多
阳气乘阴血去多，当归饮子可调和，劳伤冲任宜胶艾，摄血参 苓术莎。
涩少
涩少原来阴胜阳，或临经脉着寒凉，若然不足宜滋补，气滞津虚另有方。
不通
行后如何又不通，冷凝热结不相同，避年血少居经等，莫作寻常一例攻。
薛立斋曰∶经水阴血也，属冲任二脉，上为乳汁，下为月水，故其为患，有脾虚不能生血者，调而补之。脾
郁而血不行者，解而补之。胃火而血不成者，清而补之。脾胃虚损而血少者，温而补之。劳伤心血者，逸而补之。
怒气伤肝者，和而补之。肺气虚而不能行血者，补土以生金。肾水虚不能生肝而血少者，补脾肺以滋化源，而疾
自愈。《难经》曰∶损其肺者，益其气。损其心者，调其荣卫。损其脾者，调其饮食，适其寒温。损其肝者，缓其中。
损其肾者，益其精。皆当审而治之。
不断
经水淋浊不肯除，皆因气血本元虚，或缘房事伤冲任，郁怒忧思亦载书。
固经丸。
逾期
七七阴阳数已终，如何经脉复流通，皆因忧怒兼劳役，邪气
停留在子宫。
芩心丸。
避年
断续经期号避年，要知处女属先天，一云经度随年转，气血循环合自然。
拱辰丹。
《脉经》曰∶有妇人将一女子年十五来诊，言年十四时经水自下，今经反断，何也。师曰∶若是夫人亲女，
必夫人年十四时亦以经水下后断，所以此女亦至此而断，是为避年，后当自下。盖其气尚怯，禀赋素弱而然也。李时
珍曰∶经水一年一度者，亦为避年。
适来适断
经水将行忽着寒，适来适断不相安，触经感冒柴胡治，更刺期门可泻肝。
加味小柴胡汤。
妇人寒热如疟，昼则明白，夜则谵语，胸胁胀满，乃因血去室空，风邪乘虚而入，名曰热入血室。
当行不行
二七天癸任脉通，过期断绝不来红，风寒惊恐并思虑，养血清心勿误攻。
柏子仁丸。
大凡天癸至早者，性机巧至，迟者，性鲁钝。通行则无病，涩滞不行变成劳瘵者多矣。
[Song] Menstrual cycle irregularities are called "Qianqi" (delayed or advanced menstruation). The flow may be excessive, scanty, or lingering. Delayed onset with scanty, astringent flow is due to blood deficiency; heat excess or spleen deficiency causes early onset. Sudden fever and pain require careful differentiation. If menstruation starts and stops abruptly, observe for wind pathogens. For women over fifty, if bleeding persists, it is abnormal; for unmarried girls, amenorrhea may be "Bi Nian" (annual menstruation).
[Discussion] The *Huangdi Neijing* states: Food enters the stomach, transforms into essence and qi, which is transported upward to the spleen. The spleen scatters the essence, sending it upward to the lung, regulating water passages, and transporting it downward to the bladder. Water essence distributes throughout the body, allowing the five meridians to function in parallel. Thus, when the heart and spleen are harmonious, menstruation proceeds normally. If diet is unregulated or daily life is improper, leading to spleen and stomach deficiency, menstruation will become irregular.
Zhao Yangkui said: Early menstruation indicates fire; nourishing kidney water will calm the fire, using Liuwei Wan (Six-Ingredient Pill with Rehmannia). If early and excessive, add Haipiao Xiao (Cuttlefish Bone), Chai Hu (Bupleurum Root), and Bai Shao (White Peony Root) to the base formula. If occurring every half month or ten days, it belongs to qi deficiency, treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If delayed, there is no fire; add Ai Ye (Mugwort Leaf) to the base formula. If pulse is slow and complexion pale, add Pao Jiang (Prepared Ginger) and Rou Gui (Cinnamon Bark); this is a general principle. However, some cases have early onset without fire, delayed onset with fire, excessive flow when delayed, or scanty flow when early. One must not adhere rigidly to fixed patterns but should differentiate based on pulse speed (slow/rapid), constitution (deficiency/excess), physical strength, and age. For liver-spleen heat, modify Siwu Tang (Four-Substance Decoction). For spleen-lung deficiency, use Buzhong Yiqi Tang. For liver-spleen stagnation, use Guipi Tang (Restore the Spleen Decoction). For anger stirring liver fire, use Jia Wei Xiaoyao San (Modified Free and Easy Wanderer Powder). For liver-kidney yin deficiency, use Liuwei Wan. Since the spleen is the source of transformation and generation, and the heart commands the blood of all meridians, and yang qi arises from yin essence, it is appropriate to tonify the heart, spleen, and kidney.
[Pulse Diagnosis] If the cun (inch) and guan (bar) pulses are harmonious as usual, but the chi (cubit) pulse is absent or extremely faint, one should expect lower abdominal pain radiating to the lower back, caused by qi stagnation attacking the chest and epigastrium. If the cunkou pulse is floating and weak, floating indicates deficiency, and weak indicates lack of blood. If the pulse feels like a zither string, accompanied by severe lower abdominal pain, difficult menstruation, and sores in orifices. If the Shaoyin pulse is weak and fine, fine indicates blood deficiency, and weak indicates fever. A sinking liver pulse indicates difficult menstruation, abdominal distension, and waist pain.
Ganqian (Early Onset)
Menstruation arriving early is called "Ganqian." Causes include blood heat, yin deficiency, insecure spleen earth, anger injuring the liver, and overwork. Treat with Gujing Wan (Stabilize Menses Pill) to cool blood and ensure peace.
Formula: Siwu Sanbu Wan (Four-Substance Triple-Tonification Pill).
Luohou (Late Onset)
Due to blood deficiency, menstruation is late. Scanty flow without pain requires major tonification. Pale complexion and deficient pulse indicate insufficiency. Use Yangrong Tang (Nourish the Ying Decoction), Guishao (Angelica and Peony), and Renshen (Ginseng).
Formula: Zixue Tang (Nourish Blood Decoction).
Guoduo (Excessive Flow)
Yang qi invading yin leads to excessive blood loss. Danggui Yinzi (Danggui Drink) can harmonize. For damage to Chong and Ren meridians due to labor, use Jiao'ai Tang (Donkey-Hide Gelatin and Artemisia Decoction), combined with Renshen (Ginseng), Fuling (Poria), Baizhu (Atractylodes Macrocephala Rhizome), and Shacao (Sedge Rhizome) to control bleeding.
Seshao (Scanty Flow)
Scanty flow originally stems from yin excess and yang deficiency, or cold exposure during menstruation. If due to insufficiency, tonify; if due to qi stagnation and fluid deficiency, use other formulas.
Butong (Amenorrhea)
Why does menstruation stop after starting? Cold condensation and heat binding differ. Consider Bi Nian (annual menstruation), blood deficiency, and Ju Jing (residential menstruation); do not treat all cases with standard purgative methods.
Xue Lizhai said: Menstruation is yin blood, belonging to the Chong and Ren meridians, transforming into milk upwards and menstruation downwards. Pathologies arise from: spleen deficiency failing to generate blood (regulate and tonify); spleen stagnation blocking blood flow (resolve and tonify); stomach fire preventing blood formation (clear and tonify); spleen-stomach deficiency causing blood shortage (warm and tonify); labor damaging heart blood (rest and tonify); anger injuring the liver (harmonize and tonify); lung qi deficiency failing to move blood (tonify spleen earth to generate lung metal); kidney water deficiency failing to nourish liver causing blood shortage (tonify spleen and lung to nourish the source of transformation, leading to self-healing). The *Nanjing* states: Damage to the lung benefits qi; damage to the heart regulates Ying and Wei; damage to the spleen regulates diet and adapts to cold/warmth; damage to the liver soothes the interior; damage to the kidney benefits essence. All must be treated after careful examination.
Buduan (Lingering/Non-stop)
Menstrual blood dripping turbidly and refusing to cease is due to fundamental deficiency of qi and blood, or sexual activity damaging Chong and Ren meridians, or depression, anger, worry, and thought.
Formula: Gujing Wan (Stabilize Menses Pill).
Yuqi (Long-term Delay/Amenorrhea)
At forty-nine (seven sevens), the numbers of yin and yang end. Why does menstruation flow again? It is due to worry, anger, and labor, with pathogenic qi lingering in the uterus.
Formula: Qinxin Wan (Scutellaria Heart Pill).
Bi Nian (Annual Menstruation)
Intermittent menstruation is called "Bi Nian." Understand that virgins belong to congenital constitution. Some say menstrual cycles follow the years, with qi and blood circulation conforming to nature.
Formula: Gongchen Dan (Arch Support Pill).
The *Maijing* records: A woman brought her fifteen-year-old daughter for consultation, stating that menstruation began at fourteen but has now stopped. The master said: If she is the biological daughter, the mother likely experienced cessation after menarche at fourteen. Thus, this girl also ceases here, known as "Bi Nian," and will resume naturally later. This is because her qi is still timid and her constitution is inherently weak. Li Shizhen said: Menstruation occurring once a year is also called "Bi Nian."
Shilai Duan (Abrupt Cessation)
If cold is contracted just before menstruation begins, causing abrupt cessation and discomfort, treat wind-cold invasion with Chai Hu (Bupleurum Root). Additionally, puncture Qimen (LR14) to drain liver fire.
Formula: Jia Wei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction).
Women experiencing chills and fever like malaria, clear during the day but delirious at night, with fullness and distension in the chest and hypochondrium, suffer from "Re Ru Xue Shi" (Heat Entering the Blood Chamber) due to wind pathogens entering the void left by blood loss.
Dangxing Buxing (Should Flow But Does Not)
At fourteen (two sevens), Tian Gui arrives, and the Ren meridian becomes patent. If menstruation is absent beyond the expected time due to wind-cold, fright, fear, and worry, nourish blood and clear the heart; do not mistakenly use purgatives.
Formula: Baizi Ren Wan (Biota Seed Pill).
Generally, early arrival of Tian Gui indicates precocious sexual maturity; late arrival indicates dullness. Normal flow implies health; stagnation often leads to consumptive diseases (Lao Zhai).